Claims Recovery Specialist II

Job Summary

Working remotely in a full-time capacity, the Claims Recovery Specialist II will review and audit medical and dental claims to recover overpayments, manage active recovery efforts, and collaborate with various departments to ensure accurate claims adjustments.

Key responsibilities

• Review, audit, and initiate recovery efforts for overpaid medical and dental claims, ensuring proper documentation throughout the process
• Contact carriers, members, and providers to recover and settle claims, addressing inquiries and adjusting claims to reflect cash returns
• Distribute correspondence to policyholders for recouping overpaid claims and participate in training sessions to improve audit and recoupment knowledge

Required qualifications

• High School Diploma or GED
• 5 years of claims processing experience
• 1 year of adjustment processing experience preferred
• Strong mathematical aptitude
• Ability to meet deadlines and manage multiple customer service demands